Ectopic pregnancy: signs, symptoms, treatment. Diseases after which ectopic pregnancy develops. Ectopic pregnancy, signs, symptoms, consequences

The development of a fertilized egg outside the uterine cavity is classified in gynecology as an ectopic pregnancy. The pathology, of course, ends with the death of the fetal egg, and there are several options for the development of events when the fetal egg is localized outside the uterus.

Types of ectopic pregnancy

The classification of the pathology in question depends on the localization of the fertilized egg in the fallopian tubes. Gynecologists distinguish several types of intrauterine pregnancy:

ovarian - the fertilized egg does not go beyond the ovary and begins to develop in it;
abdominal - the fertilized egg is “pushed out” by the ovary, but does not enter the uterus, but is attached to the peritoneum;
tubal – the embryo grows and develops directly in the fallopian (uterine) tube;
rudimentary - pregnancy develops in the rudimentary process of the uterus.

Ovarian pregnancy is diagnosed extremely rarely, but under certain circumstances it can fully develop and result in the birth of a healthy child - this, of course, is an exception that does occur.

The ovary is different high level elasticity of the walls of the organ, so the growth of the fertilized egg continues long time absolutely asymptomatic for a woman - only the standard symptoms of conception occur. Therefore, timely registration of a pregnant woman with a gynecologist and a full examination can be called the only possibility for early diagnosis of an ectopic pregnancy of the ovarian type. An ultrasound examination will show an empty uterine cavity and an excessively enlarged ovary - this serves as an absolute basis for diagnosing a pathological ovarian pregnancy.

Abdominal pregnancy is also considered a rare pathology, but recently it is increasingly diagnosed during IVF. In this case, we are talking about a primary or secondary ectopic abdominal pregnancy:

primary - the fertilized egg is attached not in the uterine cavity, but in the retroperitoneal space - on the omentum, intestines;
secondary - a tubal ectopic pregnancy initially developed, then a rupture/tear of the fallopian tube occurred and the fertilized egg entered the retroperitoneal region.

There are cases of successful completion of abdominal pregnancies around the world - healthy children were born through surgical intervention.

Ectopic pregnancy developing in the rudimentary part (horn) of the uterus, always ends in the death of the fetus. Overstretching of the walls of the rudimentary horn occurs, and then their rupture.

Most often diagnosed tubal pregnancy– out of 100% of patients, 87% have this type of pathological pregnancy.

Causes

The main causes of ectopic pregnancy are considered to be pathological changes in the structure of the appendages, disruption of peristalsis (muscle activity, due to which the fertilized egg moves into the uterine cavity) of the fallopian tubes and changes in the properties of the fertilized egg. But gynecologists also identify several factors that can lead to the development of the pathology in question:

Chronic inflammatory processes in organs reproductive system. They lead to the appearance of adhesions, disrupt the structure of the ovaries and fallopian tubes, and provoke ovarian dysfunction. Particular attention should be paid to infection with chlamydia - it is this infection that leads to ectopic pregnancy in 60% of all cases.
Contraceptives for intrauterine use - spiral. According to some experts, wearing intrauterine device causes the development of inflammatory processes in the uterus and its appendages (based on the principle that the body resists the presence foreign body). In addition, there are confirmed facts that using an intrauterine device as a contraceptive for more than 5 years in a row increases the risk of developing a pathological pregnancy by 5 times.
Frequent abortions. Artificial termination of pregnancy is a sudden restructuring of the body's endocrine system, a disruption in the production of female hormones, the formation of adhesions, and a disturbance in the peristalsis of the fallopian tubes. The more often a woman has had abortions, the higher the risk of developing an ectopic (ectopic) pregnancy - a fact confirmed by research.
Disturbances in the production of hormones. First of all, we are talking about chronic endocrinological diseases, but long-term use of hormonal contraceptives can provoke an imbalance.

In addition, an ectopic pregnancy can develop as a consequence of:

neoplasms of malignant and benign nature;
infantilism of the uterus and appendages;
chronic endometriosis, which leads to the formation of adhesions;
congenital anomalies of the development of the organs of the reproductive system.

Gynecologists consider the risk of ectopic (ectopic) pregnancy in women over 35 years of age during the first conception, and in the case of frequent stress, fatigue and nervous breakdowns.

Signs of an ectopic pregnancy in the early stages

It is generally accepted that there are no symptoms of ectopic pregnancy and such pathology can be detected only at the stage of rupture of the fallopian tube or with an early ultrasound examination. And in fact early symptoms exists - it is important to timely “catch” pathological changes in the body.

Firstly, a woman may not have a banal delay in her periods, but a very meager manifestation of them. Moreover, the delay can last several days, then mild bleeding appears.

Secondly, the woman will feel pain in the lower abdomen - this is a reaction to the stretching of the fallopian tube. The pain syndrome is aching, pulling in nature, there is irradiation to the lumbar spine and anus, which leads to the erroneous assumption of an exacerbation of chronic adnexitis.

In general, official statistics make the following statements:

standard delay of menstruation during ectopic pregnancy is observed in 78% of women;
pain syndrome with localization in the lower abdomen of various types, present in 68% of women with ectopic pregnancy;
early toxicosis is diagnosed in 54% of women;
enlarged mammary glands with a little pain are noted by 36% of women with ectopic pregnancy.

When examining a woman, an ectopic pregnancy will manifest itself with the following signs:

cyanosis and friability of the cervix;
upon palpation of the appendages - a slightly enlarged fallopian tube on the side where the ectopic pregnancy develops;
an attempt to deviate the uterus leads to intense pain.

The gynecologist will note a discrepancy between the size of the uterus and the timing of the last menstruation - this also gives reason to suspect an ectopic pregnancy. But not a single specialist will make a final diagnosis without a full examination of the woman - ultrasound, analysis of progesterone levels (the hormone that maintains pregnancy), clarification of hCG levels during ectopic pregnancy.

You can get more detailed information about the symptoms of ectopic pregnancy by watching this video review:

Consequences of ectopic pregnancy

Tubal abortion

We are talking about the rejection of the fertilized egg from the fallopian tube without rupture of the appendage. Tubal abortion is characterized by three main features:

sharp pain in the lower abdomen - paroxysmal, has a “dagger” character;
bleeding appears from the vagina;
the usual menstrual cycle is disrupted - menstruation is delayed.

Intense pain in the lower abdomen appears due to an attempt to push the fertilized egg through the fallopian tube, as well as due to blood entering the retroperitoneal space - this irritates the nerve endings.

The reason to note a tubal abortion is sudden pain, which occurs with a certain frequency and can radiate to the area of the collarbone, lumbar region and anus. note: pain increases significantly with sudden movements, coughing, sneezing and during defecation.

Bloody discharge appears with constant regularity, does not have any odor and does not disappear even after taking hemostatic medications. If the diagnosis is incorrect, a woman may be prescribed mechanical cleansing of the uterine cavity, but even this measure does not stop the discharge.

note: a woman can sluggishly ignore these signs tubal abortion If the pain is not intense, bleeding does not cause discomfort. You should be wary of: hyperthermia (increased body temperature), general weakness, regular dizziness (against the background of internal bleeding).

Rupture of the fallopian tube

Rupture of the fallopian tube during ectopic pregnancy is the most severe complication, which can be fatal for a woman. This condition always occurs suddenly and has pronounced symptoms:

Any examination of a woman in this condition is not required - hemorrhagic shock, loss of consciousness and deafening pain in a previously diagnosed pregnancy serve as the basis for emergency surgical care.

Surgery

An ectopic pregnancy is always a surgical procedure. There are several types of surgical solutions to the problem:

salpingectomy - complete removal of the fallopian tube;
salpingotomy - an incision is made in the wall of the fallopian tube, through which the fertilized egg is removed;
Segmental tube resection - the fertilized egg is cut out along with a section of the tube, then the edges are sutured.

Salpingectomy is performed in most cases because ectopic pregnancy is diagnosed too late, at 4-8 weeks, when the process of embryo release/death has already begun. Salpingotomy is the best option for those who are still planning a pregnancy, but subject to early diagnosis of the pathology in question. Pipe resection is used extremely rarely and is an extraordinary operation, but usually ends successfully.

note: at the most early stages ectopic pregnancy, it is possible to destroy the fertilized egg and get rid of it without cutting/removing the fallopian tube. To do this, Methotrexate, a drug that literally dissolves the fertilized egg, is injected into the tube through the vaginal vault.

Important : This procedure is carried out only under constant ultrasound control.

After surgical treatment of ectopic pregnancy, a woman must undergo a rehabilitation period - it will be long.

Firstly, it is advisable to undergo a full examination by doctors of narrow specialties to find out the true reason for the failure of the fertilized egg to descend into the uterine cavity. Only by carrying out therapeutic measures in relation to infectious and inflammatory processes in the organs of the reproductive system can the development of a normal pregnancy be expected in the future.

Third, gynecologists warn about the undesirability of planning pregnancy in the first 6 months after surgical intervention regarding ectopic (ectopic) pregnancy. The doctor may prescribe hormonal contraceptives - this will help restore hormonal levels and prevent unplanned conception.

Preventive measures

An ectopic pregnancy cannot be predicted - there are too many factors that can lead to such a development. But doctors have developed specific preventive measures:

from the moment of sexual activity, regularly visit a gynecologist for preventive examinations and early diagnosis of inflammatory/infectious diseases;
keep a calendar of the menstrual cycle and, in case of minor irregularities, consult a gynecologist;
promptly and fully treat any pathologies of the reproductive system organs, including inflammatory and infectious diseases;
plan your pregnancy - for example, before conceiving, undergo a full examination by general and specialized doctors.

Ectopic pregnancy is considered a rather complex and dangerous pathology. But if medical events were carried out at an early stage of the pathology or if competent measures were taken when the fallopian tube ruptured, then the prognosis will be favorable. Modern advances in medicine make it possible not only to save a woman’s life, but also to provide her with the opportunity to have children in the future.

More details about ectopic pregnancy in the video review:

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category.

An ectopic pregnancy is a pregnancy characterized by implantation and development of the fertilized egg outside the uterus - in the abdominal cavity, ovary, or fallopian tube. Ectopic pregnancy is a serious and dangerous pathology, fraught with complications and relapses (recurrence), leading to loss reproductive function and even a threat to a woman's life. Localized in addition to the uterine cavity, which is the only physiologically adapted for full development fetus, a fertilized egg can lead to rupture of the organ in which it develops.

General information

The development of a normal pregnancy occurs in the uterine cavity. After the fusion of the egg with the sperm in the fallopian tube, the fertilized egg, which has begun dividing, moves into the uterus, where the necessary conditions are physiologically provided for the further development of the fetus. The duration of pregnancy is determined by the location and size of the uterus. Normally, in the absence of pregnancy, the uterus is fixed in the pelvis, between the bladder and rectum, and is about 5 cm wide and 8 cm long. Pregnancy at 6 weeks can already be determined by some enlargement of the uterus. At 8 weeks of pregnancy, the uterus enlarges to the size of a woman's fist. By the 16th week of pregnancy, the uterus is located between the womb and the navel. During a pregnancy of 24 weeks, the uterus is located at the level of the navel, and by the 28th week the fundus of the uterus is already located above the navel.

At 36 weeks of pregnancy, the fundus of the uterus reaches the costal arches and the xiphoid process. By the 40th week of pregnancy, the uterus is fixed between the xiphoid process and the navel. Pregnancy for a period of 32 weeks of gestation is established both by the date of the last menstruation and the date of the first movement of the fetus, and by the size of the uterus and the height of its standing. If for some reason the fertilized egg does not pass from the fallopian tube into the uterine cavity, a tubal ectopic pregnancy develops (in 95% of cases). In rare cases, the development of an ectopic pregnancy in the ovary or abdominal cavity has been noted.

IN last years there is a 5-fold increase in the number of cases of ectopic pregnancy (data from the US Center for Disease Control). In 7-22% of women, a recurrence of ectopic pregnancy was noted, which in more than half of the cases leads to secondary infertility. Compared to healthy women patients who have had an ectopic pregnancy have a greater (7-13 times) risk of it re-development. Most often, women from 23 to 40 years old have a right-sided ectopic pregnancy. In 99% of cases, the development of ectopic pregnancy is noted in certain parts of the fallopian tube.

General information

Ectopic pregnancy is a serious and dangerous pathology, fraught with complications and relapses (recurrence), leading to loss of reproductive function and even a threat to a woman’s life. Being localized in addition to the uterine cavity, which is the only physiologically adapted for the full development of the fetus, a fertilized egg can lead to rupture of the organ in which it develops. In practice, ectopic pregnancy of various localizations occurs.

Tubal pregnancy is characterized by the location of the fertilized egg in the fallopian tube. It is observed in 97.7% of cases of ectopic pregnancy. In 50% of cases, the fertilized egg is located in the ampullary region, in 40% - in the middle part of the tube, in 2-3% of cases - in the uterine part and in 5-10% of cases - in the area of the fimbriae of the tube. Rarely observed forms of ectopic pregnancy include ovarian, cervical, abdominal, intraligamentary forms, as well as ectopic pregnancy localized in the rudimentary uterine horn.

Ovarian pregnancy (noted in 0.2-1.3% of cases) is divided into intrafollicular (the egg is fertilized inside the ovulated follicle) and ovarian (the fertilized egg is fixed on the surface of the ovary). Abdominal pregnancy (occurs in 0.1 - 1.4% of cases) develops when the fertilized egg exits into the abdominal cavity, where it attaches to the peritoneum, omentum, intestines, and other organs. The development of abdominal pregnancy is possible as a result of IVF in case of infertility of the patient. Cervical pregnancy (0.1-0.4% of cases) occurs when the fertilized egg is implanted in the area of the columnar epithelium of the cervical canal. It ends with profuse bleeding as a result of destruction of tissues and blood vessels caused by deep penetration of the fertilized egg villi into the muscular layer of the cervix.

Ectopic pregnancy in the accessory horn of the uterus (0.2-0.9% of cases) develops with abnormalities in the structure of the uterus. Despite the intrauterine attachment of the fertilized egg, the symptoms of pregnancy are similar to the clinical manifestations of uterine rupture. Intraligamentary ectopic pregnancy (0.1% of cases) is characterized by the development of the fertilized egg between the layers of the broad ligaments of the uterus, where it is implanted when the fallopian tube ruptures. Heterotopic (multiple) pregnancy is extremely rare (1 case in 100-620 pregnancies) and is possible as a result of using IVF (assisted reproduction method). It is characterized by the presence of one fertilized egg in the uterus and the other outside it.

Signs of an ectopic pregnancy

Signs of the occurrence and development of ectopic pregnancy can include the following manifestations:

Menstrual irregularities (delayed menstruation);
Bloody, “spotting” discharge from the genitals;
Pain in the lower abdomen (pulling pain in the area where the fertilized egg is attached);
Breast engorgement, nausea, vomiting, lack of appetite.

An interrupted tubal pregnancy is accompanied by symptoms of intra-abdominal bleeding caused by the effusion of blood into the abdominal cavity. Characterized by sharp pain in the lower abdomen, radiating to the anus, legs and lower back; after pain occurs, bleeding or brown spotting from the genitals is noted. There is a decrease in blood pressure, weakness, rapid and weak pulse, and loss of consciousness. In the early stages, it is extremely difficult to diagnose an ectopic pregnancy; because the clinical picture is not typical, appeal for medical assistance should only be used if certain complications develop.

Clinical picture of interrupted tubal pregnancy coincides with the symptoms of ovarian apoplexy. Patients with symptoms of “acute abdomen” are urgently taken to a medical facility. It is necessary to immediately determine the presence of an ectopic pregnancy, perform surgery and eliminate the bleeding. Modern diagnostic methods make it possible to use ultrasound equipment and tests to determine the level of progesterone (“pregnancy hormone”) to determine the presence of an ectopic pregnancy. All medical efforts are aimed at preserving the fallopian tube. To avoid serious consequences of ectopic pregnancy, it is necessary to observe a doctor at the first suspicion of pregnancy.

Causes of ectopic pregnancy

Diagnosis of ectopic pregnancy

In the early stages, ectopic pregnancy is difficult to diagnose because clinical manifestations pathologies are atypical. As with intrauterine pregnancy, there is a delay in menstruation, changes in the digestive system (perversion of taste, attacks of nausea, vomiting, etc.), softening of the uterus and the formation of a corpus luteum of pregnancy in the ovary. An interrupted tubal pregnancy is difficult to distinguish from appendicitis, ovarian apoplexy or other acute surgical pathology of the abdominal cavity and pelvis.

If an interrupted tubal pregnancy occurs, which is a threat to life, a quick diagnosis and immediate surgical intervention are required. The diagnosis of “ectopic pregnancy” can be completely excluded or confirmed using an ultrasound examination (the presence of a fertilized egg in the uterus, the presence of fluid in the abdominal cavity and formations in the appendage area are determined).

An informative way to determine ectopic pregnancy is β -HG test. The test determines the level human chorionic gonadotropin(β-hCG), produced by the body during pregnancy. The norms for its content during intrauterine and ectopic pregnancy differ significantly, which makes this diagnostic method highly reliable. Thanks to the fact that today surgical gynecology widely uses laparoscopy as a method of diagnosis and treatment, it has become possible to diagnose ectopic pregnancy with 100% accuracy and eliminate the pathology.

Treatment of ectopic pregnancy

To treat the tubal form of ectopic pregnancy, the following types of laparoscopic operations are used: tubectomy (removal of the fallopian tube) and tubotomy (preservation of the fallopian tube while removing the fertilized egg). The choice of method depends on the situation and the degree of complication of the ectopic pregnancy. When preserving the fallopian tube, the risk of recurrence of an ectopic pregnancy in the same tube is taken into account.

When choosing a treatment method for ectopic pregnancy, the following factors are taken into account:

The patient's intention to plan a pregnancy in the future.
The feasibility of preserving the fallopian tube (depending on how pronounced the structural changes in the tube wall are).
A repeated ectopic pregnancy in a preserved tube dictates the need for its removal.
Development of ectopic pregnancy in the interstitial part of the tube.
The development of adhesions in the pelvic area and, in connection with this, an increasing risk of recurrent ectopic pregnancy.

In case of large blood loss, the only option to save the patient’s life is abdominal surgery (laparotomy) and removal of the fallopian tube. If the condition of the remaining fallopian tube remains unchanged, reproductive function is not impaired, and the woman can have a pregnancy in the future. To establish an objective picture of the condition of the fallopian tube remaining after laparotomy, laparoscopy is recommended. This method also allows the separation of adhesions in the pelvis, which serves to reduce the risk of another ectopic pregnancy in the remaining fallopian tube.

Prevention of ectopic pregnancy

To prevent the occurrence of ectopic pregnancy, you must:

prevent the development of inflammation of the genitourinary system, and if inflammation occurs, treat it in a timely manner
before a planned pregnancy, undergo examination for the presence of pathogenic microbes (chlamydia, ureaplasma, mycoplasma, etc.). If they are detected, it is necessary to undergo appropriate treatment together with your husband (regular sexual partner)
protect yourself from unwanted pregnancy during sexual activity, using reliable contraceptives, avoid abortions (the main factor provoking ectopic pregnancy)
if it is necessary to terminate an unwanted pregnancy, choose low-traumatic methods (mini-abortion) at the optimal time (the first 8 weeks of pregnancy), and the termination must be carried out in a medical institution by a qualified specialist, with pain relief and further medical supervision. Vacuum abortion (mini-abortion) reduces the time of the operation, has few contraindications and significantly fewer undesirable consequences
As an alternative to surgical termination of pregnancy, you can choose medical termination of pregnancy (taking the drug Mifegin or Mifepristone)
after an ectopic pregnancy, undergo a rehabilitation course to maintain the possibility of having another pregnancy. To preserve reproductive function, it is important to be observed by a gynecologist and gynecologist-endocrinologist and follow their recommendations. A year after the operation, you can plan a new pregnancy, if it occurs, it is necessary to register for pregnancy management in the early stages. The prognosis is favorable.

No one is immune from ectopic pregnancy, but life does not end there. Doctors say that reconception is possible. But you have to prepare well for it.

Causes of ectopic pregnancy

The main cause of ectopic pregnancy is that the fertilized egg, without passing through the fallopian tube, remains in it. The fetus began to develop outside the uterus. If an ectopic pregnancy occurs, it is impossible to save the fetus, so men and women faced with a similar problem experience real stress. Do not forget that all the consequences associated with such fertilization are very serious. And this problem can only be solved with surgery. In the best case, the result of such a conception can be a damaged fallopian tube; in the worst case, the fallopian tube is removed. If the operation is not performed on time, internal bleeding may occur, which will lead to death.

After removal of the fallopian tube, a woman planning to have a child can only hope that she will be able to get pregnant with only one tube.

Experts quite often argue that after an ectopic pregnancy, you need to prepare very carefully for the next fertilization. A woman after undergoing surgery should monitor her health. Of course, in this case, the chances of getting pregnant are reduced by half or more. Very often, women who have had an ectopic pregnancy may experience the same result again, or the next pregnancy ends in miscarriage. But still, conception after such an event is possible, and it is quite real.

Planning a pregnancy

During a manual examination, the doctor may suspect an ectopic pregnancy if there is abdominal tenderness and pain in the uterus. In addition, in approximately half of the cases, a space-occupying formation is detected in the area of the uterine appendages. In 25% of cases of ectopic pregnancy, an increase in the size of the uterus is observed. A serious cause for concern is a sharp stabbing pain followed by bleeding, a significant deterioration in general condition, and fainting. In this case, you need to seek medical help as quickly as possible, since pain may occur due to a ruptured pipe and be accompanied by internal bleeding. Delay threatens large blood loss, infertility and, in especially severe cases, death.

If a woman suspects she has an ectopic pregnancy that does not appear, have her blood tested. This pathology can be identified by the levels of progesterone and chorionic hormone in the blood. Hormone levels will be reduced compared to a normal pregnancy. To obtain more reliable information, blood tests for hormones are performed every two days. If the level of human chorionic gonadotropin is higher than in the absence of pregnancy, but the pregnancy itself is not detected, you need to undergo an ultrasound. However, using this diagnostic method it is not always possible to detect an ectopic pregnancy. There is a high probability that the accumulation of fluid or blood clots will be mistaken for a fertilized egg.

Most effective method detection of ectopic pregnancy - surgical. It allows you to accurately and quickly make a diagnosis, as well as eliminate pathology. Laparoscopy makes it possible to examine organs, assess their condition, and even perform an operation such as removing existing adhesions and restoring tube patency. It is not used if significant blood loss has occurred and is observed. In this case, an operation is performed.

Video on the topic

Tip 11: Which doctors should you see before pregnancy?

Pregnancy is a very important step for almost every woman. For everything to go well, you need to prepare in advance. The main thing you need to do is visit some specialists.

Instructions

For the next nine months, the gynecologist will become the chief physician. It is best to go in advance to the specialist who will manage the pregnancy throughout the entire period. At the appointment, the doctor will examine the medical record, make an opinion on the woman’s health status, receive information about previous pregnancies, abortions, past diseases, issue an opinion on the state of the reproductive system, take a smear, give a referral for blood and urine tests, refer for examination to the necessary specialists, will advise multivitamin complexes and proper diet.

The therapist will find out the presence or predisposition to any diseases in a woman that could interfere with conceiving or bearing a child. The doctor will conduct a test for hidden or chronic diseases, which during pregnancy can harm the mother or. All detected diseases must be treated in advance before pregnancy. In addition, the doctor will learn about the health status of the future father and other immediate relatives. The therapist will issue a written report on the state of health, which will subsequently be useful to the gynecologist.

Before, a woman definitely needs to visit a dentist. This is due to the fact that during pregnancy hormonal levels change, impairing blood circulation in the mucous membranes of the gums. This often leads to bleeding or gum disease, such as periodontitis. In addition, calcium metabolism in the body is disrupted; the body’s need for it increases significantly, because a growing child takes all the substances it needs from the mother’s body. This is reflected in the bone tissue of the expectant mother, including teeth. The dentist will assess the condition of the teeth and gums and, if necessary, prescribe treatment.

Throat and will give directions for tests.

The most important step is to visit a geneticist in advance. This will allow us to assess the risk of having a child with birth defects in development or hereditary diseases. It is necessary to meet with a geneticist in the following cases: if pathologies transmitted through the family are observed; the examined couple had already given birth to children with hereditary diseases; there are problems with conception; future parents are related; future parents want a child of a certain gender; if the expectant mother is over 35 years old and the father is 40 years old; one of the parents lived or worked in hazardous or environmentally poor areas. If future parents can collect as much information as possible about hereditary diseases in their families, then the geneticist will be able to realistically assess the risk of giving birth to a sick child and give the necessary recommendations.

Tip 12: What hormones should you take during pregnancy after IVF?

In vitro fertilization is today the main option for getting pregnant in case of infertility. Its effectiveness has been proven for all forms of infertility; in addition, IVF is often the only solution for couples in which the man is infertile. If conception is successful using this method, women are prescribed certain hormonal medications to help carry the child to term.

For infertility, sperm does not need to be combined with eggs in a test tube - it is simply injected into the uterine cavity, where the sperm independently fulfill their purpose.

After placing the fertilized egg in the uterus, the woman is prescribed hormonal drugs that maintain the tone of the uterine mucosa and significantly increase the likelihood of successfully bearing a child. Thus, to prepare the ovaries, subcutaneous injections of Decapeptyl and Diferelin are usually used, and premature ovulation at the final stage of stimulation is prevented with intramuscular injections of Cetrotide and Ogralutran.

To regulate the process of follicle maturation, Puregon and Menopur are used subcutaneously or intramuscularly, and to complete the maturation of the eggs, Profasi and Pregnil are prescribed. The drugs "Duphaston" and "Utrozhestan" are used to prepare the uterine mucosa for embryo transfer and are used after fertilization until twelve to fourteen weeks of pregnancy, when the formation of the placenta ends, which begins to secrete its own necessary hormones (progesterone).

Ectopic pregnancy

In a normal pregnancy, the ovary releases an egg into the fallopian tube and, if the egg meets a sperm, the fertilized egg travels to the uterus, implants, and continues to grow for the next nine months. In an ectopic pregnancy (or tubal pregnancy), the fertilized egg remains in the fallopian tube. In rare cases, a fertilized egg will attach to one of the ovaries or another organ in the abdomen. In even rarer cases, the embryo attaches to the part of the fallopian tube that penetrates the muscular layer of the uterus, outside the uterine cavity.

Most often, an ectopic pregnancy is diagnosed in the 8th week of pregnancy. The woman may not even know it, especially since some women with ectopic pregnancy continue to menstruate.

Diagnosis of ectopic pregnancy

An ectopic pregnancy can happen to any woman, and there are plenty of reasons for this. And since it can put a woman's life at risk, it is important to recognize the symptoms as early as possible and seek medical help immediately.

Main symptoms of ectopic pregnancy:
- vaginal bleeding (dark in color);
- nausea and vomiting;
- pain in the lower abdomen;
- abdominal cramps;
- pain on one side of the body;
- pain in the neck or rectum;
- weakness or dizziness.

Sometimes in the early stages it is very difficult to diagnose an ectopic pregnancy even with the help of ultrasound, since the fertilized egg is still small in size and may be located outside the fallopian tubes. In such cases, a regular pregnancy test can be used. Since this test reacts to the presence of hCG in the urine (and in an ectopic pregnancy, the implanted fertilized egg releases hCG into the woman’s blood), the result will be positive, that is, two stripes will appear.

In a normal pregnancy, height hCG hormone increases 3 times every two days. The home test reacts to hCG in urine from 25 units, this indicator usually occurs already on the 11th day after fertilization. During an ectopic pregnancy, the hCG hormone increases much more slowly, therefore, as a rule, the second line on the test will be fuzzy and weakly expressed.

When diagnosing an ectopic pregnancy using home tests, it is necessary to conduct several tests over time and compare the results. If the second strip also remains much lighter than the first, you should immediately consult a doctor and show him these tests.

The most common cause of violation hormonal levels- serious disruptions in the functioning of the thyroid gland. Normally, it produces enough thyroid hormones, which directly affect the speed and intensity of metabolism.

The more active thyroid, the more hormones it synthesizes, the better the body functions, processing food into energy rather than storing it for future use.

In most obese people, thyroid hormones are produced in insufficient quantities; as a result, even quite severe dietary restrictions do not allow significant results to be obtained. The body cannot cope with even small amounts of food, making reserves of them. As a result, there is no energy left for life, so many fat people characterized by lethargy, apathy and drowsiness.

The thyroid gland can be boosted a little by simply supplementing your diet with foods high in iodine. First of all, this applies to sea fish and algae. It should be noted that sea kale is especially useful in this regard, as it contains a huge amount of microelements that stimulate weight loss.

Weight loss hormones - to take or not?

Taking thyroid hormones can harm the body. Unless absolutely necessary, you should not take a course of such drugs, since the body simply gets used to the supply of necessary substances from the outside and begins to reduce their production. Hormone therapy is recommended for people who have chronic disorders of the thyroid gland.

If you decide to take such a step, be sure to consult with good specialist. Please note that the longer you take synthesized hormones, the sooner serious addiction to them occurs. So, take such drugs one time at a time with irregular breaks: you take two or three days, then you take week break. This will stimulate weight loss, but at the same time reduce the likelihood of negative consequences.

Before reaching the age of thirty, the human body actively synthesizes growth hormones, they utilize fat and maintain energy levels. With age, their number decreases significantly. To slow down this process, it is necessary to provide yourself with enough sleep, since during night rest the synthesis of growth hormones increases several times. Lack of sleep reduces the production of these hormones significantly, which leads to lethargy, apathy and unpleasant changes in your figure.

American studies have shown that the artificial introduction of these hormones into the body leads to malignant degeneration and unpleasant diseases, for example, to diabetes.

An ectopic pregnancy is a pathological pregnancy in which the implantation and development of a fertilized egg does not occur in the uterine cavity, but outside it, usually in the fallopian tube. This pathology is extremely dangerous to the health of a pregnant woman and threatens her life. How before by a doctor Once a diagnosis is established, the fewer complications and consequences a pathological pregnancy will bring. How to determine an ectopic pregnancy, what are the reasons for its occurrence and can it be prevented?

Ectopic pregnancy is one of the most severe pathologies of pregnancy, which has been quite common in the last decade. About 2-2.5% of all pregnancies are ectopic. The danger of the pathology is that untimely diagnosis of the problem and surgical intervention (embryo removal) can cause infertility or lead to the death of the woman. Why does this phenomenon occur?

As you know, pregnancy begins with the fertilization of an egg by a sperm. The fertilized egg, moving through the tube, enters the uterine cavity, attaches to one of the walls, and continues to actively develop there. In a pathological pregnancy, the egg does not move to the uterus, but remains to develop on the wall of one of the fallopian tubes; it is also possible for it to attach to the ovary or abdominal cavity. The further course of pregnancy and the development of the fetus outside the uterus is physiologically impossible, therefore such a pregnancy is considered a pathology and requires surgical intervention by removing the embryo. In approximately 95% of all pathological cases, the embryo is implanted in the fallopian (fallopian) tube, attaches to its walls and continues to grow. The fruit, increasing in size, can rupture the pipe. The woman experiences a painful shock and may lose consciousness. There is a high probability of heavy blood loss.

Ectopic pregnancy, photo

Classification of ectopic pregnancy

Based on where the embryo is attached, there are different types of ectopic pregnancy:

Pipe. The most common pathology in which the development of the zygote occurs not in the uterus, but in the fallopian tube. As a rule, after 6-8 weeks a woman experiences a spontaneous abortion or a more dangerous outcome of pregnancy - a ruptured tube, accompanied by internal bleeding. The patient requires emergency surgery.
Ovarian This type of ectopic pregnancy occurs less frequently. In this case, the maturation of the egg occurs in the follicle, without leaving it, it prepares for fertilization. Conception occurs inside or from the outer wall of the ovary. Diagnosing an ovarian pregnancy is difficult because it can be mistaken for a tumor. The end of pregnancy occurs after the follicle ruptures.
Cervical and cervical-isthmus VB. One of the rare types of pathology is that the zygote is fixed in the area of the cervical canal or isthmus, although its fertilization occurs in the uterus. This extremely dangerous phenomenon poses a threat to a woman’s life; there is a risk of developing sepsis and heavy bleeding.
Abdominal VB. It develops extremely rarely; the fertilized egg is implanted on the internal organs of the woman’s abdominal cavity.

Ectopic pregnancy: possible causes of pathology

There may be several reasons for the development of pathological pregnancy:

Impaired functioning of the fallopian tubes due to chronic gynecological diseases genital area. Due to insufficient contraction of the fallopian tubes, the egg cannot move freely along them to its main goal - the uterus; it is forced to remain in the tube and develop there.
Abnormal structure and anatomical features of the fallopian tubes. Such as infantilism, when the tubes are too narrow, twisted, advancement of the fertilized egg.
Scars formed on the tubes as a result of previous operations or abortions can become an obstacle to the advancement of the egg.
Slowness of sperm: the egg, being in the fallopian tube, waits for fertilization, and does not have time to reach the uterine cavity in time, it is attached to the walls of the tube.
The presence of a contraceptive intrauterine device in the uterus.
Hormonal contraception.
Endometriosis.
Ovulation stimulation and assisted reproduction methods.
Tumor processes in the appendages and uterus.
If an ectopic pregnancy has already developed previously.

To exclude possible causes of pathological pregnancy, a woman should undergo a pelvic examination and necessary tests during pregnancy planning.

Ectopic pregnancy: symptoms

The insidiousness and unpredictability of ectopic pregnancy is that it is very difficult to determine it independently in the early stages, especially for inexperienced pregnant women who have become pregnant for the first time. Signs of an ectopic pregnancy are identical to normal pregnancy: delayed menstruation, breast tenderness, frequent urination, toxicosis, nausea, drowsiness and fatigue. But, with pathological implantation of an embryo outside the uterus, there are certain features:

Nagging pain, which is concentrated not only in the lower abdomen, but also in the area where the fertilized egg has not implanted properly. A woman feels a sharp sharp pain during bowel movements, which radiates to the anus, and Bladder. Over time, the pain only intensifies. A little later, pain covers the entire peritoneum. Intensity pain occurs with increasing pain, the pain can be cramping and sharp.
Spotting brownish or brown discharge or scanty periods during ectopic pregnancy, which are short-term in nature. It is important not to mistake them for menstruation if there was a long delay.
General malaise, drowsiness, decreased performance, chills, increased body temperature, dizziness, fainting, decreased blood pressure.
Basal temperature. The level of BT will vary depending on where the egg is attached. During the inflammatory process, as a result of improper implantation of the egg, BT will be high. If the embryo has stopped its development, its readings will be below normal.

Does the test show an ectopic pregnancy?

A test done during an ectopic pregnancy will be positive, but one of the stripes will be very weakly expressed, this is due to low hCG level in urine. When repeated home test, after a certain period of time, the test may be negative and this should alert you. Such indicators are a reason to consult a gynecologist.

Consequences of ectopic pregnancy

In the early stages, 6-8 weeks of pregnancy, when the fetus is actively growing not in the uterus, but in the tube, the walls of the tube rupture, and cases of heavy bleeding into the peritoneum are not uncommon, and the woman experiences a painful shock.
At the same time, tubal self-abortion can occur, when the embryo exfoliates on its own and enters the abdominal cavity or uterus.
The functioning of internal organs is impaired due to blood loss.
In particularly dangerous situations, doctors are forced to remove the fallopian tube in order to save the woman’s life. After one tube is removed, a woman can become pregnant.
Sometimes the situation is so serious that the woman cannot be saved, and death cannot be ruled out.

Ectopic pregnancy: diagnosis

Only a doctor, having carried out all the necessary tests and examinations, will be able to accurately diagnose the pathology. Such examinations include:

Blood test for hCG hormone levels. With an ectopic pregnancy, pregnancy hormone levels rise more slowly, with a delay of 2 days, than with normal pregnancy developing pregnancy.
The patient is sent for an ultrasound examination. However, you can see an ectopic pregnancy using ultrasound no earlier than the 5th week of pregnancy, since the size of the embryo is still too small. Transvaginal ultrasound can most accurately establish the diagnosis and demonstrate an ectopic pregnancy.
Carrying out laparoscopic diagnostics. The patient's pelvic organs are examined using a special medical device. If, upon examination, the fertilized egg is found in an atypical place, the pregnancy is terminated. The procedure is carried out only if an accurate diagnosis cannot be established using hCG analysis and ultrasound examination. Competent and timely diagnosis of pathological pregnancy helps to avoid undesirable consequences and protect the woman from complications and death.

How to treat an ectopic pregnancy: necessary measures

After confirming the diagnosis, the patient is prescribed treatment, which includes preparation for surgery - embryo removal, and subsequent rehabilitation of the patient. Unfortunately, it is impossible to save the fetus during an ectopic pregnancy. Therefore, all measures are aimed exclusively at preserving the health and life of the mother. Termination of an ectopic pregnancy is carried out in several ways, the choice of method depends on the severity of the pathology and the duration of pregnancy, critical deadline, before which it is possible to avoid complications - 6-8 weeks.

Termination of an ectopic pregnancy using a hormonal drug (Mifepristone or Methotrexate), artificially provoking a miscarriage. This method is used in the first weeks of pregnancy, after the diagnosis has been clarified and only under the supervision of an experienced doctor.
Laparoscopy - surgical intervention is carried out using a laparoscope - an optical medical device with which the embryo is removed. The operation is low-traumatic and safe, it is performed under general anesthesia, it allows you to painlessly remove the embryo, while preserving and not injuring the fallopian tube. After rehabilitation, the patient has every chance of becoming pregnant again.
If the pathology is not diagnosed in a timely manner, the tube may rupture and bleeding may begin. This condition is very life-threatening and requires immediate surgery - salpectomy, in which the fallopian tube is removed. The chance of conceiving a child in this case is halved. The main thing is to maintain the normal functioning of the ovary in the second fallopian tube. According to statistics, it is more difficult for women over the age of 35 to conceive a child with one fallopian tube, since by this age the patency of the oviduct decreases due to the presence of chronic gynecological diseases of the genital area, the presence of adhesions, and scars on its stacks. However, even with complete obstruction of one fallopian tube, it is possible to conceive a baby using IVF.

After surgery - rehabilitation

Any surgical intervention is stressful for the body. A woman needs to restore her health and undergo rehabilitation, the duration of which depends on how dangerous the situation was for her and what consequences it entailed for the body. As a rule, after laparoscopy it will take 2-3 weeks for rehabilitation, and after removal of the fallopian tube – up to 1.5 months. The rehabilitation period includes activities such as:

Taking painkillers in the first days after surgery.
A woman can return to normal life on the 3rd day after laparoscopy, and only 3 weeks after removal of the tube.
Prohibited sexual intimacy within 1-2 months.
Compulsory contraception is necessary to avoid unwanted pregnancy. It is recommended to plan the desired pregnancy after an ectopic pregnancy no earlier than six months later.
A vacation at the seaside or resort treatment can help raise morale and improve psychological health; it is also recommended to take a course of psychological assistance.
After successful removal of the embryo from the tube, the woman must undergo a full examination for obstruction of the fallopian tubes, the presence of fibroids, cysts, tumors and other neoplasms, and if they are detected, undergo treatment so that the unpleasant situation does not happen again.

Can an ectopic pregnancy happen again?

The probability of a repeat pathological pregnancy is about 15-20%. Women who have had to undergo surgery should remember that the first ectopic pregnancy is not a death sentence; they have every chance of becoming pregnant again and carrying a baby. To prevent re-implantation of the fertilized egg outside the uterus, it is necessary to undergo the necessary examinations and pay attention to the treatment of gynecological diseases and elimination of the causes that caused the pathology.

Prevention of ectopic pregnancy

To avoid the development of a pathological pregnancy, especially if there has already been negative experience ectopic pregnancy, a woman needs to take preventive measures even when planning a baby and eliminate all factors that provoke the attachment of the fertilized egg outside the uterine cavity. The following recommendations should be observed:

Protect yourself from sexually transmitted infections and prevent inflammatory processes in the genitourinary area. If it was not possible to avoid inflammation, carry out treatment in a timely manner and do not start the disease, which can become chronic.
Before planning to conceive, it is mandatory to undergo all necessary examinations for the presence of pathogenic microbes in the body. If ureaplasma, chlamydia, or mycoplasma are detected, undergo a course of treatment together with the future father of the child.
If pregnancy is not planned, contraception must be used to prevent unwanted conception in order to avoid abortion. A previous abortion is one of the factors that provokes embryo implantation outside the uterus.
Visit your gynecologist regularly.

Knowing the main symptoms of the pathology, you can avoid dangerous and undesirable consequences and suspect an ectopic pregnancy in time. Self-medication is fraught with serious consequences; you cannot do without the help of doctors. At the first symptoms or suspicion of a pathological pregnancy, immediately contact your gynecologist. Only a qualified physician, with the help of the necessary examinations and tests, can make a diagnosis and take all necessary treatment measures to preserve your health.

Ectopic pregnancy is a pregnancy pathology in which a fertilized egg implants ( attached) outside the uterine cavity. This disease is extremely dangerous, as it threatens to damage the woman’s internal genital organs with the development of bleeding, and therefore requires immediate medical care.

The place of development of an ectopic pregnancy depends on many factors and in the vast majority of cases ( 98 – 99% ) falls on the fallopian tubes ( since a fertilized egg passes through them on its way from the ovaries to the uterine cavity). In the remaining cases, it develops on the ovaries, in the abdominal cavity ( implantation on intestinal loops, liver, omentum), on the cervix.

In the evolution of ectopic pregnancy, it is customary to distinguish the following stages:

It is necessary to understand that the stage of ectopic pregnancy at which the diagnosis occurred determines further prognosis and therapeutic tactics. The earlier this disease is detected, the more favorable the prognosis. However early diagnosis is associated with a number of difficulties, since in 50% of women this disease is not accompanied by any specific signs that would suggest it without additional examination. The occurrence of symptoms is most often associated with the development of complications and bleeding ( 20% of women have massive internal bleeding at the time of diagnosis).

The incidence of ectopic pregnancy is 0.25 – 1.4% among all pregnancies ( including among registered abortions, spontaneous abortions, stillbirths, etc.). Over the past few decades, the frequency of this disease has increased slightly, and in some regions it has increased 4 to 5 times compared to the figure twenty to thirty years ago.

Maternal mortality due to complications of ectopic pregnancy averages 4.9% in developing countries, and less than one percent in countries with advanced medical care. The main cause of mortality is delay in treatment and misdiagnosis. About half of ectopic pregnancies remain undiagnosed until complications develop. Reducing the mortality rate can be achieved thanks to modern diagnostic methods and minimally invasive treatment methods.

Interesting Facts:

cases of simultaneous occurrence of ectopic and normal pregnancies have been reported;
cases of ectopic pregnancy simultaneously in two fallopian tubes have been reported;
the literature describes cases of multiple ectopic pregnancies;
Isolated cases of full-term ectopic pregnancy have been described in which the placenta was attached to the liver or omentum ( organs with sufficient area and blood supply);
In extremely rare cases, ectopic pregnancy can develop in the cervical uterus, as well as in a rudimentary horn that does not communicate with the uterine cavity;
the risk of developing an ectopic pregnancy increases with age and reaches a maximum after 35 years;
In vitro fertilization carries a tenfold risk of developing an ectopic pregnancy ( associated with hormonal imbalances);
The risk of developing an ectopic pregnancy is higher among women who have a medical history of ectopic pregnancies, recurrent miscarriages, inflammatory diseases of the internal genital organs, and operations on the fallopian tubes.

Anatomy and physiology of the uterus at conception

To better understand how an ectopic pregnancy occurs, as well as to understand the mechanisms that can provoke it, it is necessary to understand how normal conception and implantation of the fertilized egg occurs.

Fertilization is the process of fusion of male and female reproductive cells - sperm and egg. This usually happens after sexual intercourse, when sperm pass from the vaginal cavity through the uterine cavity and fallopian tubes to the egg released from the ovaries.

Eggs are synthesized in the ovaries - the female genital organs, which also have a hormonal function. In the ovaries, during the first half of the menstrual cycle, gradual maturation of the egg occurs ( usually one egg per menstrual cycle), with changes and preparation for fertilization. In parallel with this, the inner mucous layer of the uterus undergoes a number of structural changes ( endometrium), which thickens and prepares to accept the fertilized egg for implantation.

Fertilization becomes possible only after ovulation has occurred, that is, after the mature egg has left the follicle ( structural component of the ovary in which the maturation of the egg occurs). This happens approximately in the middle of the menstrual cycle. The egg released from the follicle, together with the cells attached to it, forming the corona radiata ( outer shell that performs a protective function), falls on the fringed end of the fallopian tube from the corresponding side ( although there have been cases where in women with one functioning ovary the egg ended up in the tube on the opposite side) and is transported by the cilia of the cells lining the inner surface of the fallopian tubes deep into the organ. Fertilization ( meeting with sperm) occurs in the widest ampullary part of the tube. After this, the already fertilized egg, with the help of the cilia of the epithelium, as well as due to the fluid flow directed to the uterine cavity and resulting from the secretion of epithelial cells, moves through the entire fallopian tube to the uterine cavity, where its implantation occurs.

It should be noted that the female body has several mechanisms that cause a delay in the advancement of the fertilized egg into the uterine cavity. This is necessary so that the egg has time to go through several stages of division and prepare for implantation before entering the uterine cavity. Otherwise, the fertilized egg may be unable to penetrate the endometrium and may be carried into the external environment.

The delay in the advancement of the fertilized egg is ensured by the following mechanisms:

Folds of the mucous membrane of the fallopian tubes. The folds of the mucous membrane significantly slow down the advancement of the fertilized egg, since, firstly, they increase the path that it must travel, and secondly, they delay the flow of fluid carrying the egg.
Spastic contraction of the isthmus of the fallopian tube ( part of the tube located 15 - 20 mm before the entrance to the uterus). The isthmus of the fallopian tube is in a spastic state ( permanent) contractions for several days after ovulation. This makes it much more difficult for the egg to move forward.

With the normal functioning of the female body, these mechanisms are eliminated within a few days, due to an increase in the secretion of progesterone - female hormone, which serves to maintain pregnancy and is produced by the corpus luteum ( part of the ovary from which the egg is released).

Upon reaching a certain stage of development of the fertilized egg ( blastocyst stage, in which the embryo consists of hundreds of cells) the implantation process begins. This process, which takes place 5 to 7 days after ovulation and fertilization, and which should normally occur in the uterine cavity, is the result of the activity of special cells located on the surface of the fertilized egg. These cells secrete special substances that melt the cells and structure of the endometrium, which allows them to penetrate the mucous layer of the uterus. After the implantation of the fertilized egg has occurred, its cells begin to multiply and form the placenta and other embryonic organs necessary for the development of the embryo.

Thus, during the process of fertilization and implantation, there are several mechanisms, the disruption of which can cause incorrect implantation, or implantation in a place other than the uterine cavity.

Disturbance in the activity of these structures can lead to the development of ectopic pregnancy:

Impaired contraction of the fallopian tubes to promote sperm. The movement of sperm from the uterine cavity to the ampullary part of the fallopian tube occurs against the flow of fluid and, accordingly, is difficult. Contraction of the fallopian tubes promotes faster movement of sperm. A disruption of this process may cause an earlier or later meeting of the egg with the sperm and, accordingly, the processes relating to the advancement and implantation of the fertilized egg may proceed somewhat differently.
Impaired movement of epithelial cilia. The movement of epithelial cilia is activated by estrogens, female sex hormones produced by the ovaries. The movements of the cilia are directed from the outer part of the tube to its entrance, in other words, from the ovaries to the uterus. In the absence of movements, or if they are in the opposite direction, the fertilized egg can remain in place for a long time or move in the opposite direction.
Stability of spastic spasm of the isthmus of the fallopian tube. Spastic contraction of the fallopian tube is eliminated by progesterones. If their production is disrupted, or for any other reason, this spasm may persist and cause retention of the fertilized egg in the lumen of the fallopian tubes.
Impaired secretion of fallopian epithelial cells ( uterine) pipes The secretory activity of fallopian tube epithelial cells forms a fluid flow that promotes the advancement of the egg. In its absence, this process slows down significantly.
Violation of the contractile activity of the fallopian tubes to promote the fertilized egg. Contraction of the fallopian tubes not only promotes the movement of sperm from the uterine cavity to the egg, but also the movement of the fertilized egg to the uterine cavity. However, even under normal conditions, the contractile activity of the fallopian tubes is quite weak, but, nevertheless, it facilitates the advancement of the egg ( which is especially important in the presence of other disorders).

Despite the fact that an ectopic pregnancy develops outside the uterine cavity, that is, on those tissues that are not intended for implantation, the early stages of the formation and formation of the fetus and embryonic organs ( placenta, amniotic sac, etc.) happen normally. However, in the future the course of pregnancy is inevitably disrupted. This may occur due to the fact that the placenta, which forms in the lumen of the fallopian tubes ( more often) or on other organs, destroys blood vessels and provokes the development of hematosalpinx ( accumulation of blood in the lumen of the fallopian tube), intra-abdominal bleeding, or both at the same time. Usually this process is accompanied by abortion of the fetus. In addition, there is an extremely high chance that the growing fetus will cause a ruptured tube or serious damage to other internal organs.

Causes of ectopic pregnancy

Ectopic pregnancy is a pathology for which there is no one strictly defined cause or risk factor. This disease can develop under the influence of many different factors, some of which still remain unidentified.

In the vast majority of cases, ectopic pregnancy occurs due to a disruption in the transport of the egg or fertilized egg, or due to excessive activity of the blastocyst ( one of the stages of development of the fertilized egg). All this leads to the fact that the implantation process begins at a time when the fertilized egg has not yet reached the uterine cavity ( a separate case is an ectopic pregnancy localized in the cervix, which may be associated with delayed implantation or too rapid advancement of the fertilized egg, but which occurs extremely rarely).

An ectopic pregnancy can develop for the following reasons:

Premature blastocyst activity. In some cases, premature activity of the blastocyst with the release of enzymes that help melt tissue for implantation can cause an ectopic pregnancy. This may be due to some genetic abnormalities, exposure to any toxic substances, as well as hormonal imbalances. All this leads to the fact that the fertilized egg begins to implant in the segment of the fallopian tube in which it is located this moment.
Impaired movement of the fertilized egg through the fallopian tubes. Violation of the movement of the fertilized egg through the fallopian tube leads to the fact that the fertilized egg is retained in some segment of the tube ( or outside it, if it was not captured by the fimbriae of the fallopian tube), and upon the onset of a certain stage of embryo development, it begins to implant in the corresponding region.

Impaired movement of a fertilized egg into the uterine cavity is considered the most common cause of ectopic pregnancy and can occur due to many different structural and functional changes.

Impaired movement of the fertilized egg through the fallopian tubes can be caused by the following reasons:

inflammatory process in the uterine appendages;
operations on the fallopian tubes and abdominal organs;
hormonal imbalances;
fallopian tube endometriosis;
congenital anomalies;
tumors in the pelvis;
exposure to toxic substances.

Inflammatory process in the uterine appendages

Inflammatory process in the uterine appendages ( fallopian tubes, ovaries) is the most common cause of ectopic pregnancy. The risk of developing this pathology is high as in acute salpingitis ( inflammation of the fallopian tubes), as well as chronic. Moreover, infectious agents, which are the most common cause of inflammation, cause structural and functional changes in the tissue of the fallopian tubes, against the background of which there is an extremely high probability of disruption of the advancement of the fertilized egg.

Inflammation in the uterine appendages can be caused by many damaging factors ( toxins, radiation, autoimmune processes, etc.), however most often it occurs in response to the penetration of an infectious agent. Studies in which women with salpingitis took part found that in the vast majority of cases this disease is provoked by facultative pathogens ( cause disease only in the presence of predisposing factors), among which the most important are the strains that make up the normal human microflora ( coli). The causative agents of sexually transmitted diseases, although somewhat less common, pose a great danger, as they have pronounced pathogenic properties. Quite often, damage to the uterine appendages is associated with chlamydia - a sexually transmitted infection, which is extremely characterized by a latent course.

Infectious agents can enter the fallopian tubes in the following ways:

Ascending path. Most infectious agents are introduced through the ascending route. This occurs with the gradual spread of an infectious-inflammatory process from the lower genital tract ( vagina and cervix) upward – to the uterine cavity and fallopian tubes. This path is typical for pathogens of sexually transmitted infections, fungi, opportunistic bacteria, and pyogenic bacteria.
Lymphogenic or hematogenous route. In some cases, infectious agents can be introduced into the uterine appendages along with the flow of lymph or blood from infectious and inflammatory foci in other organs ( tuberculosis, staphylococcal infection, etc.).
Direct introduction of infectious agents. Direct introduction of infectious agents into the fallopian tubes is possible during medical manipulations on the pelvic organs, without observing the proper rules of asepsis and antiseptics ( abortions or ectopic manipulations outside medical institutions ), as well as after open or penetrating wounds.
By contact. Infectious agents can penetrate the fallopian tubes through direct contact with infectious and inflammatory foci on the abdominal organs.

Dysfunction of the fallopian tubes is associated with the direct impact of pathogenic bacteria on their structure, as well as with the inflammatory reaction itself, which, although aimed at limiting and eliminating the infectious focus, can cause significant local damage.

The impact of the infectious-inflammatory process on the fallopian tubes has the following consequences:

The activity of the cilia of the mucous layer of the fallopian tubes is disrupted. Changes in the activity of the cilia of the epithelium of the fallopian tubes are associated with a change in the environment in the lumen of the tubes, with a decrease in their sensitivity to the action of hormones, as well as with partial or complete destruction of the cilia.
The composition and viscosity of the secretion of epithelial cells of the fallopian tubes changes. The impact of pro-inflammatory substances and bacterial waste products on the cells of the mucous membrane of the fallopian tubes causes a disruption of their secretory activity, which leads to a decrease in the amount of fluid produced, a change in its composition and an increase in viscosity. All this significantly slows down the progress of the egg.
Swelling occurs, narrowing the lumen of the fallopian tube. The inflammatory process is always accompanied by swelling caused by tissue edema. This swelling in such a limited space as the lumen of the fallopian tube can cause its complete blockage, which will lead either to the impossibility of conception or to an ectopic pregnancy.

Surgeries on the fallopian tubes and abdominal organs

Surgical interventions, even minimally invasive ones, are associated with some, even minimal, trauma, which can provoke some changes in the structure and function of organs. This is due to the fact that at the site of injury or defect, connective tissue is formed, which is not capable of performing a synthetic or contractile function, which occupies a slightly larger volume, and which changes the structure of the organ.

An ectopic pregnancy can be caused by the following surgical interventions:

Surgeries on the abdominal or pelvic organs that do not affect the genitals. Surgeries on the abdominal organs can indirectly affect the function of the fallopian tubes, as they can provoke adhesions, and can also cause disruption of their blood supply or innervation ( accidental or intentional intersection or injury of blood vessels and nerves during surgery).
Operations on the genital organs. The need for surgery on the fallopian tubes arises in the presence of any pathologies ( tumor, abscess, infectious-inflammatory focus, ectopic pregnancy). After the formation of connective tissue at the site of the incision and suture, the ability of the pipe to contract changes and its mobility is impaired. In addition, its internal diameter may decrease.

Separately, mention should be made of such a method of female sterilization as tubal ligation. This method involves applying ligatures to the fallopian tubes ( sometimes – their intersection or cauterization) during surgery. However, in some cases this method of sterilization is not effective enough, and pregnancy still occurs. However, since due to ligation of the fallopian tube its lumen is significantly narrowed, normal migration of the fertilized egg into the uterine cavity becomes impossible, which leads to the fact that it implants in the fallopian tube and an ectopic pregnancy develops.

Hormonal imbalances

Normal operation hormonal system is extremely important for maintaining pregnancy, as hormones control the process of ovulation, fertilization and the movement of the fertilized egg through the fallopian tubes. If there are any disruptions in endocrine function, these processes may be disrupted, and an ectopic pregnancy may develop.

Of particular importance in regulating the functioning of the organs of the reproductive system are steroid hormones produced by the ovaries - progesterone and estrogen. These hormones have slightly different effects, since normally the peak concentrations of each of them occur at different phases of the menstrual cycle and pregnancy.

Progesterone has the following effects:

inhibits the movement of cilia of the tubal epithelium;
reduces the contractile activity of the smooth muscles of the fallopian tubes.

Estrogen has the following effects:

increases the frequency of flickering of the cilia of the tubal epithelium ( too high a concentration of the hormone can cause their immobilization);
stimulates the contractile activity of the smooth muscles of the fallopian tubes;
influences the development of the fallopian tubes during the formation of the genital organs.

Normal cyclic changes in the concentration of these hormones make it possible to create optimal conditions for fertilization and migration of the fertilized egg. Any changes in their level can cause the egg to be retained and implanted outside the uterine cavity.

The following factors contribute to changes in the level of sex hormones:

disruption of ovarian function;
disruptions of the menstrual cycle;
use of progestin-only oral contraceptives ( synthetic progesterone analogue);
emergency contraception ( levonorgestrel, mifepristone);
induction of ovulation using clomiphene or gonadotropin injections;
neurological and autonomic disorders.

Other hormones also, to varying degrees, take part in the regulation reproductive function. A change in their concentration up or down can have extremely adverse consequences for pregnancy.

Disruption of the following internal secretion organs can provoke an ectopic pregnancy:

Thyroid. Thyroid hormones are responsible for many metabolic processes, including the transformation of certain substances involved in the regulation of reproductive function.
Adrenal glands. The adrenal glands synthesize a number of steroid hormones that are necessary for the normal functioning of the genital organs.
Hypothalamus, pituitary gland. The hypothalamus and pituitary gland are brain structures that produce a number of hormones with regulatory activity. Disruption of their work can cause a significant disruption in the functioning of the entire body, including the reproductive system.

Endometriosis

Endometriosis is a pathology in which the functioning endometrial islets ( lining of the uterus) find themselves outside the uterine cavity ( most often - in the fallopian tubes, on the peritoneum). This disease occurs when menstrual blood containing endometrial cells flows from the uterine cavity into the abdominal cavity through the fallopian tubes. Outside the uterus, these cells take root, multiply and form foci that function and change cyclically during the menstrual cycle.

Endometriosis is a pathology, the presence of which increases the risk of developing an ectopic pregnancy. This is due to some structural and functional changes that occur in the reproductive organs.

The following changes occur with endometriosis:

the frequency of flickering of the cilia of the tubal epithelium decreases;
connective tissue is formed in the lumen of the fallopian tube;
the risk of fallopian tube infection increases.

Abnormalities of the genital organs

Abnormalities of the genital organs can cause the movement of the fertilized egg through the fallopian tubes to be difficult, slow, too long, or even impossible.

The following anomalies are of particular significance:

Genital infantilism. Genital infantilism is a delay in the development of the body, in which the genital organs have certain anatomical and functional features. For the development of ectopic pregnancy, it is of particular importance that the fallopian tubes this disease longer than usual. This increases the migration time of the fertilized egg and, accordingly, promotes implantation outside the uterine cavity.
Fallopian tube stenosis. Stenosis, or narrowing of the fallopian tubes, is a pathology that can occur not only under the influence of various external factors, but which can be congenital. Significant stenosis can cause infertility, but a less pronounced narrowing can only interfere with the process of migration of the egg to the uterine cavity.
Diverticula of the fallopian tubes and uterus. Diverticula are sac-like protrusions of the organ wall. They significantly complicate the transport of the egg, and in addition, they can act as a chronic infectious and inflammatory focus.

Tumors in the pelvis

Tumors in the pelvis can significantly affect the process of transporting the egg through the fallopian tubes, since, firstly, they can cause a change in the position of the genital organs or their compression, and secondly, they can directly change the diameter of the lumen of the fallopian tubes and the function of epithelial cells. In addition, the development of some tumors is associated with hormonal and metabolic disorders, which, one way or another, affect the reproductive function of the body.

Exposure to toxic substances

Under the influence of toxic substances, the functioning of most organs and systems of the human body is disrupted. The longer a woman is exposed to harmful substances, and the greater the amount of them that enters the body, the more serious disorders they can provoke.

Ectopic pregnancy can occur due to exposure to a variety of toxic substances. Special attention The toxins contained in tobacco smoke, alcohol and drugs deserve attention, as they are widespread and increase the risk of developing the disease by more than three times. In addition, industrial dust, heavy metal salts, various toxic fumes and other factors that often accompany these processes also have a strong impact on the mother’s body and her reproductive function.

Toxic substances cause the following changes in the reproductive system:

delayed ovulation;
change in contraction of the fallopian tubes;
decreased frequency of movement of cilia of the tubal epithelium;
impaired immunity with an increased risk of infection of the internal genital organs;
changes in local and general blood circulation;
changes in hormone concentrations;
neurovegetative disorders.

In Vitro Fertilization

In vitro fertilization deserves special attention, as it is one of the ways to combat infertility in a couple. With artificial insemination, the process of conception ( fusion of egg with sperm) occurs outside the woman's body, and viable embryos are placed artificially in the uterus. This method of conception is associated with a higher risk of developing an ectopic pregnancy. This is explained by the fact that women who resort to this species fertilization, there are already pathologies of the fallopian tubes or other parts of the reproductive system.

Risk factors

As mentioned above, ectopic pregnancy is a disease that can be caused by many different factors. Based on the possible causes and mechanisms underlying their development, as well as on the basis of many years of clinical research, a number of risk factors have been identified, that is, factors that significantly increase the likelihood of developing an ectopic pregnancy.

Risk factors for the development of ectopic pregnancy are:

previous ectopic pregnancies;
infertility and its treatment in the past;
in vitro fertilization;
stimulation of ovulation;
progestin contraceptives;
mother's age is more than 35 years;
promiscuity;
ineffective sterilization by ligating or cauterizing the fallopian tubes;
infections of the upper genitalia;
congenital and acquired anomalies of the genital organs;
operations on the abdominal organs;
infectious and inflammatory diseases of the abdominal cavity and pelvic organs;
neurological disorders;
stress;
passive lifestyle.

Symptoms of ectopic pregnancy

Symptoms of an ectopic pregnancy depend on the phase of its development. During the period of progressive ectopic pregnancy, any specific symptoms are usually absent, and during pregnancy termination, which can occur as a tubal abortion or tube rupture, a clear clinical picture of an acute abdomen arises, requiring immediate hospitalization.

Signs of a progressive ectopic pregnancy

Progressive ectopic pregnancy, in the vast majority of cases, is no different in clinical course from normal intrauterine pregnancy. Throughout the entire period while fetal development occurs, presumptive ( subjective sensations experienced by a pregnant woman) and probable ( detected during an objective examination) signs of pregnancy.

Presumptive(dubious)signs of pregnancy are:

changes in appetite and taste preferences;
drowsiness;
frequent change mood;
irritability;
increased sensitivity to odors;
increased sensitivity of the mammary glands.

Possible signs of pregnancy are:

cessation of menstruation in a woman who is sexually active and of childbearing age;
bluish color ( cyanosis) mucous membrane of the genital organs - vagina and cervix;
engorgement of the mammary glands;
release of colostrum from the mammary glands when pressed ( only relevant during first pregnancy);
softening of the uterus;
contraction and hardening of the uterus during the examination followed by softening;
asymmetry of the uterus in early pregnancy;
cervical mobility.

The presence of these signs in many cases indicates a developing pregnancy, and at the same time, these symptoms are the same for both physiological pregnancy and ectopic pregnancy. It should be noted that doubtful and probable signs can be caused not only by fetal development, but also by certain pathologies ( tumors, infections, stress, etc.).

Reliable signs of pregnancy ( fetal heartbeat, fetal movements, palpation of large parts of the fetus) during ectopic pregnancy occur extremely rarely, since they are characteristic of later stages of intrauterine development, before the onset of which various complications usually develop - tubal abortion or tubal rupture.

In some cases, a progressive ectopic pregnancy may be accompanied by pain and bleeding from the genital tract. Moreover, this pathology of pregnancy is characterized by a small amount of discharge ( in contrast to spontaneous abortion during intrauterine pregnancy, when the pain is mild and the discharge is profuse).

Signs of tubal abortion

Tubal abortion occurs most often 2–3 weeks after the onset of delayed menstruation as a result of rejection of the fetus and its membranes. This process is accompanied by a number of symptoms characteristic of spontaneous abortion in combination with doubtful and probable ( nausea, vomiting, change in taste, delayed menstruation) signs of pregnancy.

Tubal abortion is accompanied by the following symptoms:

Periodic pain. Periodic, cramping pain in the lower abdomen is associated with contraction of the fallopian tube, as well as its possible filling with blood. The pain radiates ( give away) in the area of the rectum, perineum. The appearance of constant acute pain may indicate hemorrhage into the abdominal cavity with irritation of the peritoneum.
Bloody discharge from the genital tract. The occurrence of bloody discharge is associated with rejection of decidually changed endometrium ( part of the placental-uterine system in which metabolic processes ), as well as with partial or complete damage blood vessels. The volume of bloody discharge from the genital tract may not correspond to the degree of blood loss, since most of the blood through the lumen of the fallopian tubes can enter the abdominal cavity.
Signs of hidden bleeding. Bleeding during a tubal abortion may be insignificant, and then the woman’s general condition may not be affected. However, when the volume of blood loss is more than 500 ml, severe pain appears in the lower abdomen with irradiation to the right hypochondrium, interscapular region, and right clavicle ( associated with irritation of the peritoneum by bleeding). Weakness, dizziness, fainting, nausea, and vomiting occur. There is an increased heart rate and decreased blood pressure. A significant amount of blood in the abdominal cavity can cause an enlarged or bloated abdomen.

Signs of a ruptured fallopian tube

Rupture of the fallopian tube, which occurs under the influence of a developing and growing embryo, is accompanied by a vivid clinical picture, which usually occurs suddenly against the background of a state of complete well-being. The main problem with this type of termination of ectopic pregnancy is heavy internal bleeding, which forms the symptoms of the pathology.

A ruptured fallopian tube may be accompanied by the following symptoms:

Lower abdominal pain. Pain in the lower abdomen occurs due to a rupture of the fallopian tube, as well as due to irritation of the peritoneum by the gushing blood. The pain usually begins on the side of the “pregnant” tube with further spread to the perineum, anus, right hypochondrium, and right collarbone. The pain is constant and acute.
Weakness, loss of consciousness. Weakness and loss of consciousness occur due to hypoxia ( oxygen deficiency) of the brain, which develops due to a decrease in blood pressure ( against the background of a decrease in circulating blood volume), and also due to a decrease in the number of red blood cells that carry oxygen.
The urge to defecate, loose stool. Irritation of the peritoneum in the rectal area can provoke frequent urge to defecation, as well as loose stools.
Nausea and vomiting. Nausea and vomiting occur reflexively due to irritation of the peritoneum, as well as due to the negative effects of hypoxia on the nervous system.
Signs of hemorrhagic shock. Hemorrhagic shock occurs when there is a large amount of blood loss, which directly threatens the woman’s life. Signs of this condition are pallor skin, apathy, inhibition of nervous activity, cold sweat, shortness of breath. There is an increase in heart rate, a decrease in blood pressure ( the degree of reduction of which corresponds to the severity of blood loss).

Along with these symptoms, probable and presumptive signs of pregnancy and delayed menstruation are noted.

Diagnosis of ectopic pregnancy

Diagnosis of ectopic pregnancy is based on a clinical examination and a number of instrumental studies. The greatest difficulty is in diagnosing a progressive ectopic pregnancy, since in most cases this pathology is not accompanied by any specific signs and in the early stages it is quite easy to overlook it. Timely diagnosis progressive ectopic pregnancy helps prevent such dangerous and dangerous complications such as tubal abortion and fallopian tube rupture.

Clinical examination

Diagnosis of ectopic pregnancy begins with a clinical examination, during which the doctor identifies some specific signs indicating an ectopic pregnancy.

During a clinical examination, the general condition of the woman is assessed, palpation and percussion are performed ( percussion) and auscultation, a gynecological examination is performed. All this allows you to create a holistic picture of the pathology, which is necessary to form a preliminary diagnosis.

The data collected during the clinical examination may vary at different stages of the development of an ectopic pregnancy. With a progressive ectopic pregnancy, there is some lag in the size of the uterus; a compaction may be detected in the area of the appendages on the side corresponding to the “pregnant” tube ( which is not always possible to identify, especially in the early stages). Gynecological examination reveals cyanosis of the vagina and cervix. Signs of intrauterine pregnancy - softening of the uterus and isthmus, asymmetry of the uterus, and inflection of the uterus may be absent.

With a rupture of the fallopian tube, as well as with a tubal abortion, pale skin, rapid heartbeat, and decreased blood pressure are noted. When tapping ( percussion) there is dullness in the lower abdomen, which indicates fluid accumulation ( blood). Palpation of the abdomen is often difficult, since irritation of the peritoneum causes contraction of the muscles of the anterior abdominal wall. Gynecological examination reveals excessive mobility and softening of the uterus, severe pain when examining the cervix. Pressing on the posterior vaginal fornix, which may be flattened, causes acute pain ( "Douglas' cry").

Ultrasonography

Ultrasonography ( Ultrasound) is one of the most important examination methods, which makes it possible to diagnose an ectopic pregnancy at a fairly early stage, and which is used to confirm this diagnosis.

The following signs help diagnose an ectopic pregnancy:

enlargement of the uterine body;
thickening of the uterine mucosa without detection of the fertilized egg;
detection of a heterogeneous formation in the area of the uterine appendages;
fertilized egg with an embryo outside the uterine cavity.

Transvaginal ultrasound is of particular diagnostic importance, as it can detect pregnancy as early as 3 weeks after ovulation, or within 5 weeks after the last menstruation. This examination method is widely practiced in emergency departments and is extremely sensitive and specific.

Ultrasound diagnostics makes it possible to detect intrauterine pregnancy, the presence of which in the vast majority of cases allows us to exclude ectopic pregnancy ( cases of simultaneous development of normal intrauterine and ectopic pregnancy are extremely rare). An absolute sign of intrauterine pregnancy is the detection of a gestational sac ( term used exclusively in ultrasound diagnostics), yolk sac and the embryo in the uterine cavity.

In addition to diagnosing an ectopic pregnancy, ultrasound can detect a rupture of the fallopian tube, the accumulation of free fluid in the abdominal cavity ( blood), accumulation of blood in the lumen of the fallopian tube. This method also allows for differential diagnosis with other conditions that can cause an acute abdomen.

Women at risk, as well as women with in vitro fertilization, are subject to periodic ultrasound examinations, as they have a ten times higher chance of developing an ectopic pregnancy.

Human chorionic gonadotropin level

Human chorionic gonadotropin is a hormone that is synthesized by the tissues of the placenta, and the level of which gradually increases during pregnancy. Normally, its concentration doubles every 48 to 72 hours. During an ectopic pregnancy, human chorionic gonadotropin levels will increase much more slowly than during a normal pregnancy.

Determining the level of human chorionic gonadotropin is possible using rapid pregnancy tests ( which are characterized by a fairly high percentage of false negative results), as well as through more detailed laboratory analysis, which allows us to evaluate its concentration over time. Pregnancy tests allow you to confirm the presence of pregnancy within a short period of time and build a diagnostic strategy if you suspect an ectopic pregnancy. However, in some cases, human chorionic gonadotropin may not be detected by these tests. Termination of pregnancy, which occurs during tubal abortion and rupture of the tube, disrupts the production of this hormone, and therefore, during complications, a pregnancy test may be falsely negative.

Determining the concentration of human chorionic gonadotropin is especially valuable in combination with ultrasound examination, as it allows a more correct assessment of the signs detected on ultrasound. This is due to the fact that the level of this hormone directly depends on the period of gestational development. Comparison of data obtained from ultrasound examination and analysis of human chorionic gonadotropin allows one to judge the course of pregnancy.

Progesterone level

Determining the level of progesterone in blood plasma is another way laboratory diagnostics abnormally developing pregnancy. Its low concentration ( below 25 ng/ml) indicates the presence of pregnancy pathology. A decrease in progesterone levels below 5 ng/ml is a sign of a non-viable fetus and, regardless of the location of pregnancy, always indicates the presence of some pathology.

Progesterone levels have the following features:

does not depend on the period of gestational development;
remains relatively constant during the first trimester of pregnancy;
if the level is initially abnormal, it does not return to normal;
does not depend on the level of human chorionic gonadotropin.

However, this method is not sufficiently specific and sensitive, so it cannot be used separately from other diagnostic procedures. In addition, during in vitro fertilization it loses its significance, since during this procedure its level can be increased ( against the background of increased secretion by the ovaries due to previous stimulation of ovulation, or against the background of artificial administration of pharmacological drugs containing progesterone).

Abdominal puncture through the posterior vaginal fornix ( culdocentesis)

Abdominal puncture through the posterior vaginal fornix is used for clinical picture acute abdomen with suspected ectopic pregnancy and is a method that allows us to differentiate this pathology from a number of others.

During an ectopic pregnancy, dark, non-coagulable blood is obtained from the abdominal cavity, which does not sink when placed in a vessel with water. Microscopic examination reveals chorionic villi, particles of the fallopian tubes and endometrium.

Due to the development of more informative and modern methods diagnostics, including laparoscopy, puncture of the abdominal cavity through the posterior vaginal fornix has lost its diagnostic value.

Diagnostic curettage of the uterine cavity

Diagnostic curettage of the uterine cavity followed by histological examination of the obtained material is used only in the case of a proven pregnancy anomaly ( low levels of progesterone or human chorionic gonadotropin), for differential diagnosis with incomplete spontaneous abortion, as well as in case of reluctance or impossibility to continue pregnancy.

In case of ectopic pregnancy, the following histological changes are revealed in the obtained material:

decidual transformation of the endometrium;
absence of chorionic villi;
atypical nuclei of endometrial cells ( Arias-Stella phenomenon).

Despite the fact that diagnostic curettage of the uterine cavity is quite effective and simple method diagnosis, it can be misleading in the case of simultaneous development of intrauterine and ectopic pregnancy.

Laparoscopy

Laparoscopy is modern surgical method, which allows for minimally invasive interventions on the abdominal and pelvic organs, as well as diagnostic operations. The essence of this method is to introduce a special laparoscope instrument through a small incision into the abdominal cavity, equipped with a system of lenses and lighting, which allows you to visually assess the condition of the organs being examined. In case of ectopic pregnancy, laparoscopy makes it possible to examine the fallopian tubes, uterus, and pelvic cavity.

With an ectopic pregnancy, the following changes in the internal genital organs are detected:

thickening of the fallopian tubes;
purplish-bluish coloration of the fallopian tubes;
rupture of the fallopian tube;
fertilized egg on the ovaries, omentum or other organ;
bleeding from the lumen of the fallopian tube;
accumulation of blood in the abdominal cavity.

The advantage of laparoscopy is a fairly high sensitivity and specificity, a low degree of trauma, as well as the possibility of surgically terminating an ectopic pregnancy and eliminating bleeding and other complications immediately after diagnosis.

Laparoscopy is indicated in all cases of ectopic pregnancy, as well as if it is impossible to make an accurate diagnosis ( as the most informative diagnostic method).

Treatment of ectopic pregnancy

Is it possible to have a baby with an ectopic pregnancy?

The only organ in a woman’s body that can ensure adequate development of the fetus is the uterus. Attachment of the fertilized egg to any other organ is fraught with malnutrition, changes in structure, as well as rupture or damage to this organ. It is for this reason that ectopic pregnancy is a pathology in which bearing and giving birth to a child is impossible.

To date, there are no methods in medicine that would allow an ectopic pregnancy to occur. The literature describes several cases where, with this pathology, it was possible to carry children to a term compatible with life in the external environment. However, firstly, such cases are possible only under extremely rare circumstances ( one case in several hundred thousand ectopic pregnancies), secondly, they are associated with an extremely high risk for the mother, and thirdly, there is a possibility of the formation of pathologies in the development of the fetus.

Thus, bearing and giving birth to a child with an ectopic pregnancy is impossible. Since this pathology threatens the life of the mother and is incompatible with the life of the fetus, the most rational solution is to terminate the pregnancy immediately after diagnosis.

Is it possible to treat an ectopic pregnancy without surgery?

Historically, treatment for ectopic pregnancy was limited to surgical removal of the fetus. However, with the development of medicine, some methods of non-surgical treatment of this pathology have been proposed. The basis of such therapy is the prescription of methotrexate, a drug that is an antimetabolite that can change synthetic processes in the cell and cause a delay in cell division. This drug is widely used in oncology to treat various tumors, as well as to suppress immunity during organ transplantation.

The use of methotrexate for the treatment of ectopic pregnancy is based on its effect on fetal tissue and its embryonic organs, arresting their development and subsequent spontaneous rejection.

Drug treatment using methotrexate has a number of advantages over surgical treatment, as it reduces the risk of bleeding, negates trauma to tissues and organs, and reduces the rehabilitation period. However, this method is not without its drawbacks.

The following side effects are possible when using methotrexate:

nausea;
vomit;
stomach pathologies;
dizziness;
liver damage;
suppression of bone marrow function ( is fraught with anemia, decreased immunity, bleeding);
baldness;
rupture of the fallopian tube during progressive pregnancy.

Treatment of ectopic pregnancy with methotrexate is possible under the following conditions:

confirmed ectopic pregnancy;
hemodynamically stable patient ( no bleeding);
the size of the fertilized egg does not exceed 4 cm;
absence of fetal cardiac activity during ultrasound examination;
no signs of fallopian tube rupture;
human chorionic gonadotropin level is below 5000 IU/ml.

Treatment with methotrexate is contraindicated in the following situations:

human chorionic gonadotropin level above 5000 IU/ml;
presence of fetal cardiac activity during ultrasound examination;
hypersensitivity to methotrexate;
state of immunodeficiency;
liver damage;
leukopenia ( low white blood cell count);
thrombocytopenia ( low platelet count);
anemia ( low number of red blood cells);
active lung infection;
kidney pathology.

Treatment is carried out by parenteral ( intramuscular or intravenous) administration of the drug, which can be one-time or can last for several days. The woman is under observation throughout the entire treatment period, as there is still a risk of fallopian tube rupture or other complications.

The effectiveness of treatment is assessed by measuring the level of human chorionic gonadotropin over time. A decrease in it by more than 15% from the initial value on days 4–5 after administration of the drug indicates the success of treatment ( During the first 3 days, hormone levels may be elevated). Parallel to measurement this indicator The function of the kidneys, liver, and bone marrow is monitored.

If there is no effect from drug therapy with methotrexate, surgical intervention is prescribed.

Treatment with methotrexate is associated with many risks, since the drug can negatively affect some vital organs of a woman and does not reduce the risk of fallopian tube rupture to complete cessation pregnancy, and besides, it is not always effective enough. Therefore, the main treatment method for ectopic pregnancy is still surgery.

It is necessary to understand that conservative treatment does not always produce the expected therapeutic effect, and in addition, due to a delay in surgical intervention, some complications may occur, such as tubal rupture, tubal abortion and massive bleeding ( not to mention the side effects from methotrexate itself).

Surgery

Despite the possibilities of non-surgical therapy, surgical treatment still remains the main method of managing women with ectopic pregnancy. Surgical intervention is indicated for all women who have an ectopic pregnancy ( both developing and interrupted).

Surgical treatment is indicated in the following situations:

developing ectopic pregnancy;
interrupted ectopic pregnancy;
tubal abortion;
rupture of the fallopian tube;
internal bleeding.

The choice of surgical tactics is based on the following factors:

patient's age;
desire to have a pregnancy in the future;
condition of the fallopian tube during pregnancy;
condition of the fallopian tube on the opposite side;
localization of pregnancy;
fertilized egg size;
general condition of the patient;
volume of blood loss;
condition of the pelvic organs ( adhesive process).

Based on these factors, the choice of surgical operation is made. If there is a significant degree of blood loss, the patient’s general condition is severe, as well as the development of certain complications, a laparotomy is performed - an operation with a wide incision, which allows the surgeon to quickly stop the bleeding and stabilize the patient. In all other cases, laparoscopy is used - a surgical intervention in which manipulators and an optical system are inserted into the abdominal cavity through small incisions in the anterior abdominal wall, allowing a number of procedures to be carried out.

Laparoscopic access allows the following types of operations:

Salpingotomy ( incision of the fallopian tube with extraction of the fetus, without removing the tube itself). Salpingotomy allows you to preserve the fallopian tube and its reproductive function, which is especially important if there are no children or if the tube on the other side is damaged. However, this operation is possible only if the fetal egg is small in size, as well as if the tube itself is intact at the time of the operation. In addition, salpingotomy is associated with an increased risk of recurrent ectopic pregnancy in the future.
Salpingectomy ( removal of the fallopian tube along with the implanted fetus). Salpingectomy is a radical method in which the “pregnant” fallopian tube is removed. This type of intervention is indicated if there is an ectopic pregnancy in the woman’s medical history, as well as if the size of the ovum is more than 5 cm. In some cases, it is not possible to completely remove the tube, but only to excise the damaged part of it, which makes it possible to preserve its function to some extent.

It is necessary to understand that in most cases, intervention for ectopic pregnancy is carried out urgently to eliminate bleeding and to eliminate the consequences of tubal abortion or tube rupture, so patients end up on the operating table with minimal preliminary preparation. If we are talking about elective surgery, then women are pre-prepared ( preparation is carried out in the gynecological or surgical department, since all women with an ectopic pregnancy are subject to immediate hospitalization).

Preparation for surgery consists of the following procedures:

donating blood for general and biochemical analysis;
determination of blood group and Rh factor;
performing an electrocardiogram;
conducting ultrasound examination;
consultation with a therapist.

Postoperative period

The postoperative period is extremely important for the normalization of a woman’s condition, for eliminating certain risk factors, as well as for the rehabilitation of reproductive function.

During the postoperative period, constant monitoring of hemodynamic parameters is carried out, and painkillers, antibiotics, and anti-inflammatory drugs are administered. After laparoscopic ( minimally invasive) after surgery, women can be discharged within one to two days, but after laparotomy, hospitalization is required for a much longer period of time.

After surgery and removal of the fertilized egg, it is necessary to monitor human chorionic gonadotropin weekly. This is due to the fact that in some cases fragments of the ovum ( chorion fragments) may not be completely removed ( after operations preserving the fallopian tube), or can be transferred to other organs. This condition is potentially dangerous, since a tumor, chorionepithelioma, can begin to develop from chorion cells. To prevent this, the level of human chorionic gonadotropin is measured, which normally should decrease by 50% during the first few days after surgery. If this does not happen, methotrexate is prescribed, which can suppress the growth and development of this embryonic organ. If after this the hormone level does not decrease, there is a need for radical surgery to remove the fallopian tube.

IN postoperative period physiotherapy is prescribed ( electrophoresis, magnetic therapy), which contribute to faster restoration of reproductive function, and also reduce the likelihood of developing adhesions.

The prescription of combined oral contraceptives in the postoperative period has two goals - stabilization of menstrual function and prevention of pregnancy in the first 6 months after surgery, when the risk of development various pathologies pregnancy is extremely high.

Prevention of ectopic pregnancy

What should you do to avoid an ectopic pregnancy?

To reduce the likelihood of developing an ectopic pregnancy, the following recommendations should be followed:

promptly treat infectious diseases of the genital organs;
periodically undergo an ultrasound examination or donate blood to check the level of human chorionic gonadotropin during in vitro fertilization;
get tested for sexually transmitted infections when changing partners;
use combined oral contraceptives to prevent unwanted pregnancy;
promptly treat diseases of internal organs;
Healthy food;
correct hormonal disorders.

What should you avoid to prevent ectopic pregnancy?

To prevent ectopic pregnancy, it is recommended to avoid:

infectious and inflammatory pathologies of the genital organs;
sexually transmitted infections;
promiscuity;
use of progestin contraceptives;
stress;
sedentary lifestyle;
smoking and other toxic exposures;
large number operations on the abdominal organs;
multiple abortions;
in vitro fertilization.